Ovarian cancer
From Medical-Wiki
The most common cause of death from a GYN cancer is ovarian cancer. This tumor spreads by local extension, lymphatic invasion, intraperitoneal implantation, hematogenous dissemination, and transdiaphragmatic passage. Unfortunately, early disease is associated with a paucity of well defined symptoms. This means that disease is usually far advanced before being diagnosed.
It appears that malignant cells most commonly implant in sites of stasis along the peritoneal fluid circulation. Because of this, treatment involves debulking surgery, and intraperitoneal administration of chemotherapy. Hematogenous spread is clinically unusual. It does, however, occur not infrequently in advanced disease.
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Demographics
The incidence of ovarian cancer is a stunning 1 out of 70 women over a lifetime. Disease prognosis is poor. There is only a 45% 5 year survival rate.
Women who have been pregnant have a 50% less chance of developing ovarian cancer. Oral contraceptives also reduce its risk. There is also a genetic factor. In women who have a first-degree family member with the disease, there is a 4% to 5% risk of its contraction (7% with two relatives.) This compares to a 1.6% chance in the normal population.
There is a special circumstance termed “hereditary ovarian cancer.” This is defined as a family in which multiple members have ovarian cancer. 2 syndromes have been identified. Breast/ovarian cancer syndrome is associated with early onset of breast or ovarian cancer. This condition follows an autosomal dominant pattern—inherited from either parent.
Lynch II Syndrome
“Lynch II syndrome” (or hereditary nonpolyposis colorectal cancer) occurs in families who are characterized by a high rate of colorectal, endometrial, stomach, small bowel, breast, pancreas, and ovarian cancers. This syndrome is caused by mutations in the mismatch repair genes. [1]
Signs & symptoms
While symptoms of early disease are minimal, there has been some agreement on what symptoms should raise an index of suspicion. These are bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urinary symptoms, such as urgent or frequent feelings of needing to go. If these occur on a daily basis, women have been instructed that they should seek a physician’s consultation. [2]
Diagnosis
National guidelines are reflective of the ability to screen for ovarian cancer in that they state that there “is no existing evidence that any screening test, including CA-125, ultrasound, or pelvic examination, reduces mortality from ovarian cancer.”
It does go on to say that, “The positive predictive value of an initially positive screening test would be more favorable for women at higher risk.“ [3]
Treatment
Treatment begins with surgical staging. At the time of staging, cytoreductive surgery should be performed by a GYN oncologist. If needed, interval debulking is then performed. [4]
